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Southern Center on Environmentally-Driven Disparities in Birth Outcomes(SCEDDBO) at Duke University

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Principal Investigator: Marie Lynn Miranda PhD

Overview
Research Projects
Community Partners

Overview


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The central mission of the Southern Center on Environmentally-Driven Disparities in Birth Outcomes is to determine how environmental, social, and host factors jointly contribute to health disparities in birth outcomes. Although it is widely agreed that maternal and fetal health and well-being are determined by multiple forces, surprisingly little is known about the interactions of those forces. For example, elevated environmental exposures often occur in communities facing multiple social stressors like deteriorating housing, inadequate access to health care, poor schools, high unemployment, high crime, and high poverty — all of which may compound the effects of environmental exposures. This phenomenon is especially severe for low income and minority pregnant mothers, with significant health implications for the fetuses they carry. In addition, despite an emerging consensus that numerous gene- environment interactions determine maternal and child health, we know little about how genetic and environmental factors combine to promote or prevent adverse outcomes. This center seeks to disentangle these complicated effects by combining rapidly evolving methods in spatial statistics, genetics, and proteomics, in complementary human and animal models of birth outcomes.

Duke Project Triangle Diagram
This diagram represents the conceptual framework of the Duke Children's Center. The figure depicts environmental, social, and host factors as three sides of an integrated triangle. "Host factors" include maternal age, genetics, personality, and co-morbidity, as well as associated biological response. Health disparities arise when the forces exerted by the triangle’s sides are asymmetrical for different population groups.
Low birthweight (LBW), preterm birth (PTB), and fetal growth restriction (FGR) all exhibit documented disparities across subpopulations. Survivors of LBW and PTB are at significant risk for both short-term neonatal morbidity as well as long-term disabilities, including respiratory distress syndrome, variable heart rate, cerebral ventriculomegaly, cerebral palsy, mental retardation, blindness, deafness, learning disabilities, behavioral disabilities, and motor impairment. Of similar importance is the impact of lower birth weight on increased risk of diabetes, obesity, cardiovascular disease and other health problems in adulthood. Thus, understanding, and eventually intervening, to prevent these adverse birth outcomes is of critical importance to the overall health of the nation.

Research Projects

Duke University Project Overview Diagram. Select image to view larger size.
Duke University Project Overview Diagram.
Select to view larger graphic.
Specific goals of the Center are to: 1) develop and operate an interdisciplinary children’s health research center with a focus on understanding how biological, physiological, environmental, and social aspects of vulnerability contribute to health disparities; 2) enhance research in children’s health at Duke by promoting research interactions among programs in biomedicine, environmental health, and the social sciences and establishing an infrastructure to support and extend interdisciplinary research; 3) develop new methodologies for incorporating innovative statistical analysis into children’s environmental health research and policy practice, with a particular emphasis on genetic and spatial analysis; 4) serve as a technical and educational resource to the local community, region, the nation, and to international agencies in the area of children’s health and health disparities; and 5) translate the results of the Center into direct interventions in clinical care and practice.

The Southern Center on Environmentally-Driven Disparities in Birth Outcomes will achieve the central mission and specific goals through the organization of an Administrative Core; three Research Projects (Research Project A: Mapping Disparities in Birth Outcomes; Research Project B: Healthy Pregnancy, Healthy Baby: Studying Racial Disparities in Birth Outcomes; and Research Project C: Perinatal Environmental Exposure Disparity and Neonatal Respiratory Health); one Facility Core (Geographic Information Systems and Statistical Analysis Core); and a Community Outreach and Translation Core. Synergies and complementarities exist across all research projects and cores.

Overlap exists between each pair of research projects, as well as among all three research projects. The Geographic Information Systems and Statistical Analysis and Administrative Cores support all three research projects, and the Community Outreach and Translation Core serves as a bi-directional bridge between the center and all its component parts and the community. The Center is governed through an Administrative Core that includes an Executive Committee and an External Advisory Committee. The Administrative Core provides scientific direction and leadership, coordinates and fosters interactions among research project and facility core investigators, and represents SCEDDBO to the outside community.

Research Project A, "Mapping Disparities in Birth Outcomes" uses a geographically-based nested study design and high-end Geographic Information Systems (GIS) applications in combination with Bayesian spatial hierarchical modeling and other advanced spatial statistical approaches to: (1) spatially link detailed birth record, fetal death certificate, socioeconomic, environmental exposure, tax assessor, community-based, and clinical obstetric data at highly resolved scales for the State of North Carolina from 1990-2003; (2) refine the conception of fetal growth restriction by developing a joint distribution for birthwcight and gestation using bivariate modeling for live births and fetal deaths - both separately and jointly; and (3) determine whether and to what extent differential exposures to both socioeconomic and environmental stressors help explain health disparities in fetal growth restriction among different ethnic and social groups.

Research Project B, "Healthy Pregnancy, Healthy Baby: Studying Racial Disparities in Birth Outcomes" is a cohort study of pregnant women in Durham, NC designed to: (1) correlate birthweight, gestational age, and birthweight x gestational age with individual-level measures of environmental, social, and host factors; (2) partner with local community groups to inventory neighborhood quality and the built environment in order to develop community-level measures of environmental and social factors; (3) create a comprehensive data architecture, spatially resolved at the tax parcel level, of environmental, social, and host factors affecting pregnant women by linking data from the cohort study and neighborhood assessments with additional environmental and socioeconomic data; and (4) determine to what extent differential exposures explain health disparities by applying innovative spatial and genetic statistical methods.

Research Project C, "Perinatal Environmental Exposure Disparity and Neonatal Respiratory Health" uses an animal model to: (1) determine whether maternal exposure to airborne particulates (PM) and/or ozone restricts fetal growth and/or postnatal growth, and impairs lung development/function in newborn mice; (2) determine whether PM and/or ozone exposure 'reprograms' maternal inflammatory responses; (3) determine whether postnatal ozone exposure further impairs postnatal somatic and lung development/function following maternal PM and/or ozone exposures; and (4) determine whether genetic or developmental susceptibility to airway hyperreactivity exacerbates maternal and/or postnatal exposure effects on postnatal somatic and lung development/function.

The Geographic Information Systems and Statistical Analysis Core: (1) provides support for the development of environmental and social data layers needed to implement the various data analyses required for the research projects and the Community Outreach and Translation Core; (2) provides statistical analysis, advice, and consulting on the broad range of statistical issues that arise in conjunction with the research projects, with a particular emphasis on data reduction methods and modeling spatial and spatio-temporal data within a Bayesian framework; and (3) provides analysis for the unique needs of genetic data arising from the clinical and animal studies of the center. This support core facilitates the development of innovative quantitative methodology for children's environmental health research associated with the projects and cores.

The Community Outreach and Translation Core: (1) conducts environmental health outreach and education directed at low income and minority women and their children; (2) enhances the capacity of disadvantaged communities to understand threats posed by environmental contaminants; and (3) provides a bridge between campus research, communities, and policy makers. The Community Outreach and Translation Core's activities utilize center expertise to promote the development of preventive outreach and education with the goal of enhancing the lives of those most vulnerable in our communities. Expected Results: The Southern Center on Environmentally-Driven Disparities in Birth Outcomes will produce important new knowledge to disentangle the complex etiology of birth outcomes. This new knowledge will point the way to effective interventions to achieve better pregnancy outcomes among all population groups.

Community Partners

The central objective of the Community Outreach and Translation Core (COTC) is to create, implement, and assess strategies to translate and apply the findings of the Southern Center on Environmentally-Driven Disparities in Birth Outcomes (SCEDDBO) into relevant information for women of childbearing age, families, community groups, policy makers, and health care professionals. The COTC will conduct environmental health outreach and education directed at low income and minority women and their children; enhance the capacity of disadvantaged communities to understand threats posed by environmental contaminants; and provide a bridge between campus research, communities and policy makers.

Partners:

Durham Congregations, Associations, and Neighborhoods (CAN) Exit EPA Disclaimer
Triangle Residential Options for Substance Abusers (TROSA) Exit EPA Disclaimer
The Durham Affordable Housing Coalition Exit EPA Disclaimer
The Partnership Effort for the Advancement of Children’s Health/Clear Corps (PEACH)
Durham People's Alliance Exit EPA Disclaimer
The Durham County Health Department
The Lincoln Community Health Center Exit EPA Disclaimer
Duke University Nursing School Exit EPA Disclaimer
Watts School of Nursing Exit EPA Disclaimer
The City of Durham Department of Neighborhood Improvement Services
The City of Durham Department of Community Development
The Children’s Environmental Health Branch of NC Department of Environment and Natural Resources
The North Carolina Asthma Alliance
East Coast Migrant Head Start Exit EPA Disclaimer
The North Carolina Community Health Center Association Exit EPA Disclaimer
The Pesticide Education Project Exit EPA Disclaimer
The North Carolina Rural Communities Assistance Project Exit EPA Disclaimer

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